Maternity Nursing NCLEX Practice PDF

1. A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert? A. Endometritis B. Endometriosis C. Salpingitis D. Pelvic thrombophlebitis 2. A client at 36 weeks gestation is scheduled for a routine u...

1. A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert? A. Endometritis B. Endometriosis C. Salpingitis D. Pelvic thrombophlebitis 2. A client at 36 weeks gestation is scheduled for a routine ultrasound prior to amniocentesis. After teaching the client about the purpose of the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction? A. The ultrasound will help to locate the placenta. B. The ultrasound identifies blood flow through the umbilical cord. C. The test will determine where to insert the needle. D. The ultrasound locates a pool of amniotic fluid. 3. While the postpartum client is receiving heparin for thrombophlebitis, which of the following drugs would the nurse expect to administer if the client develops complications related to heparin therapy? A. Calcium gluconate B. Protamine sulfate C. Methylergonovine (Methergine) D. Nitrofurantoin (Macrodantin) 4. When caring for a 3-day-old neonate who is receiving phototherapy to treat jaundice, the nurse in charge would expect to do which of the following? A. Turn the neonate every 6 hours B. Encourage the mother to discontinue breastfeeding. C. Notify the physician if the skin becomes bronze in color. D. Check the vital signs every 2 to 4 hours. 5. A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective? A. Back B. Abdomen C. Fundus D. Perineum 6. The nurse is caring for a primigravida at about 2 months and 1-week gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she says: A. “Nausea and vomiting can be decreased if I eat a few crackers before rising.”  B. “If I start to leak colostrum, I should cleanse my nipples with soap and water.” C. “If I have a vaginal discharge, I should wear nylon underwear.” D. “Leg cramps can be alleviated if I put an ice pack on the area.” 7. Forty-eight hours after delivery, the nurse in charge plans discharge teaching for the client about infant care. By this time, the nurse expects that the phase of postpartum psychological adaptation that the client would be in would be termed which of the following? A. Taking in B. Letting go C. Taking hold D. Resolution 8. A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bed rest B. Platelet infusion. C. Immediate cesarean delivery. D. Labor induction with oxytocin. 9. The nurse plans to instruct the postpartum client about methods to prevent breast engorgement. Which of the following measures would the nurse include in the teaching plan? A. Feeding the neonate a maximum of 5 minutes per side on the first day. B. Wearing a supportive brassiere with nipple shields. C. Breastfeeding the neonate at frequent intervals. D. Decreasing fluid intake for the first 24 to 48 hours. 10. When the nurse on duty accidentally bumps the bassinet, the neonate throws out its arms, hands open, and begins to cry. The nurse interprets this reaction as indicative of which of the following reflexes? A. Startle reflex B. Babinski reflex C. Grasping reflex D. Tonic neck reflex 11. A primigravida client at 25 weeks gestation visits the clinic and tells the nurse that her lower back aches when she arrives home from work. The nurse should suggest that the client perform: A. Tailor sitting B. Leg lifting  C. Shoulder circling D. Squatting exercises 12. Which of the following would the nurse in charge do first after observing a 2-cm circle of bright red bleeding on the diaper of a neonate who just had a circumcision? A. Notify the neonate’s pediatrician immediately. B. Check the diaper and circumcision again in 30 minutes. C. Secure the diaper tightly to apply pressure on the site. D. Apply gentle pressure to the site with a sterile gauze pad. 13. Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta? A. Excessive vaginal bleeding B. Rigid, board-like abdomen C. Tetanic uterine contractions D. Premature rupture of membranes 14. While the client is in active labor with twins and the cervix is 5 cm dilated, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse’s most appropriate action? A. Note the fetal heart rate patterns. B. Notify the physician immediately. C. Administer oxygen at 6 liters by mask. D. Have the client pant-blow during the contractions. 15. A client tells the nurse, “I think my baby likes to hear me talk to him.” When discussing neonates and stimulation with sound, which of the following would the nurse include as a means to elicit the best response? A. High-pitched speech with tonal variations. B. Low-pitched speech with a sameness of tone. C. Cooing sounds rather than words. D. Repeated stimulation with loud sounds. 16. A 31-year-old multipara is admitted to the birthing room after initial examination reveals her cervix to be at 8 cm, completely effaced (100 %), and at 0 station. What phase of labor is she in? A. Active phase B. Latent phase C. Expulsive phase D. Transitional phase 17.A pregnant patient asks the nurse if she can take castor oil for her constipation. How should the nurse respond? A. “Yes, it produces no adverse effect.” B. “No, it can initiate premature uterine contractions.”  C. “No, it can promote sodium retention.” D. “No, it can lead to increased absorption of fat-soluble vitamins.” 18. A patient in her 14th week of pregnancy has presented with abdominal cramping and vaginal bleeding for the past 8 hours. She has passed several clots. What is the primary nursing diagnosis for this patient? A. Knowledge deficit B. Fluid volume deficit C. Anticipatory grieving D. Pain 19. Immediately after delivery, the nurse-midwife assesses the neonate’s head for signs of molding. Which factors determine the type of molding? A. Fetal body flexion or extension B. Maternal age, body frame, and weight C. Maternal and paternal ethnic backgrounds D. Maternal parity and gravidity 20. For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied? A. The membranes must rupture. B. The fetus must be at 0 station. C. The cervix must be dilated fully. D. The patient must receive anesthesia. 21. A primigravida patient is admitted to the labor delivery area. Assessment reveals that she is in the early part of the first stage of labor. Her pain is likely to be most intense: A. Around the pelvic girdle B. Around the pelvic girdle and in the upper arms C. Around the pelvic girdle and at the perineum D. At the perineum 22. A female adult patient is taking a progestin-only oral contraceptive or mini pill. Progestin use may increase the patient’s risk for: A. Endometriosis B. Female hypogonadism C. Premenstrual syndrome D. Tubal or ectopic pregnancy 23. A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? A. Proteinuria, headaches, vaginal bleeding B. Headaches, double vision, vaginal bleeding C. Proteinuria, headaches, double vision D. Proteinuria, double vision, uterine contractions 24. Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why should the nurse monitor the patient’s fluid intake and output closely during oxytocin administration? A. Oxytocin causes water intoxication. B. Oxytocin causes excessive thirst. C. Oxytocin is toxic to the kidneys. D. Oxytocin has a diuretic effect. 25. Five hours after birth, a neonate is transferred to the nursery, where the nurse intervenes to prevent hypothermia. What is a common source of radiant heat loss? A. Low room humidity B. Cold weight scale C. Cool incubator walls D. Cool room temperature 26. After administering bethanechol to a patient with urine retention, the nurse in charge monitors the patient for adverse effects. Which is most likely to occur? A. Decreased peristalsis B. Increase heart rate C. Dry mucous membranes D. Nausea and Vomiting 27. The nurse in charge is caring for a patient who is in the first stage of labor. What is the shortest but most difficult part of this stage? A. Active phase B. Complete phase C. Latent phase D. Transitional phase 28. After 3 days of breastfeeding, a postpartum patient reports nipple soreness. To relieve her discomfort, the nurse should suggest that she: A. Apply warm compresses to her nipples just before feeding. B. Lubricate her nipples with expressed milk before feeding. C. Dry her nipples with a soft towel after feeding. D. Apply soap directly to her nipples, and then rinse. 29. The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time? A. Between 10 and 12 weeks’ gestation B. Between 16 and 20 weeks’ gestation. C. Between 21 and 23 weeks’ gestation. D. Between 24 and 26 weeks’ gestation. 30.Normal lochial findings in the first 24 hours post-delivery include: A. Bright red blood  B. Large clots or tissue fragments C. A foul odor D. The complete absence of lochia 31.Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first? A. “Do you have any chronic illness?” B. “Do you have any allergies?” C. “What is your expected due date?” D. “Who will be with you during labor?” 32.A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions? A. Every 5 minutes. B. Every 15 minutes. C. Every 30 minutes. D. Every 60 minutes. 33.A patient is in her last trimester of pregnancy. Nurse Vickie should instruct her to notify her primary health care provider immediately if she notices: A. Blurred vision B. Hemorrhoids C. Increased vaginal mucus D. Shortness of breath on exertion 34.The nurse in-charge is reviewing a patient’s prenatal history. Which finding indicates a genetic risk factor? A. The patient is 25 years old. B. The patient has a child with cystic fibrosis. C. The patient was exposed to rubella at 36 weeks’ gestation. D. The patient has a history of preterm labor at 32 weeks’ gestation 35.An adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by: A. Return preovulatory basal body temperature. B. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle. C. 3 full days of elevated basal body temperature and clear, thin cervical mucus. D. Breast tenderness and mittelschmerz. 36.During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time? A. At the beginning of each fetal movement. B. At the beginning of each contraction. C. After every three fetal movements D. At the end of fetal movement. 37.When evaluating a client’s knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her? A. “I’ll report increased frequency of urination.” B. “If I have blurred or double vision, I should call the clinic immediately.” C. “If I feel tired after resting, I should report it immediately.” D. “Nausea should be reported immediately.” 38.When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breastfeeding success? A. “It’s contraindicated for you to breastfeed following this type of surgery.” B. “I support your commitment; however, you may have to supplement each feeding with formula.” C. “You should check with your surgeon to determine whether breast-feeding would be possible.” D. “You should be able to breastfeed without difficulty.” 39.Following a precipitous delivery, examination of the client’s vagina reveals a fourth- degree laceration. Which of the following would be contraindicated when caring for this client? A. Applying cold to limit edema during the first 12 to 24 hours. B. Instructing the client to use two or more peri pads to cushion the area. C. Instructing the client on the use of sitz baths if ordered. D. Instructing the client about the importance of perineal (Kegel) exercises. 40.A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: A. An empty gestational sac. B. Grapelike clusters. C. A severely malformed fetus. D. An extrauterine pregnancy. 41. After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at (–1) station. Based on these findings, the nurse-midwife knows that the fetal presenting part is: A. 1 cm below the ischial spines. B. Directly in line with the ischial spines. C. 1 cm above the ischial spines D. In no relationship to the ischial spines. 42. Which of the following would be inappropriate to assess in a mother who’s breastfeeding? A. The attachment of the baby to the breast B. The mother’s comfort level with positioning the baby. C. Audible swallowing. D. The baby’s lips smacking. 43.During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies? A. Amniocentesis B. Chorionic villi sampling C. Fetoscopy D. Ultrasound 44.A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate? A. The fetus should be delivered within 24 hours. B. The client should repeat the test in 24 hours. C. The fetus isn’t in distress at this time. D. The client should repeat the test in 1 week. 45.A client who is 36 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client’s preparation for parenting, the nurse might ask which question? A. “Are you planning to have epidural anesthesia?” B. “Have you begun prenatal classes?” C. “What changes have you made at home to get ready for the baby?” D. “Can you tell me about the meals you typically eat each day? 46.A client who’s admitted to labor and delivery has the following assessment findings: gravida 2 para 1, estimated 40 weeks gestation, contractions 2 minutes apart, lasting 45 seconds, vertex +4 station. Which of the following would be the priority at this time? A. Placing the client in bed to begin fetal monitoring. B. Preparing for immediate delivery. C. Checking for ruptured membranes. D. Providing comfort measures. 47. The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? A. Change the client’s position. B. Prepare for an emergency cesarean section. C. Check for placenta previa. D. Administer oxygen. 48.The nurse in charge is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client? A. Risk for deficient fluid volume related to hemorrhage. B. Risk for infection related to the type of delivery. C. Pain related to the type of incision. D. Urinary retention related to periurethral edema. 49.Which change would the nurse identify as a progressive physiological change in the postpartum period? A. Lactation B. Lochia C. Uterine involution  D. Diuresis 50.A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding? A. Placenta previa B. Abruptio placentae C. Ectopic pregnancy D. Spontaneous abortion 51.A client with type 1 diabetes mellitus who is a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus: A. Weekly fetal movement counts are made by the mother. B. Contraction stress testing is performed weekly. C. Induction of labor begins at 34 weeks’ gestation. D. Nonstress testing is performed weekly until 32 weeks’ gestation. 52.When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: A. Prevent seizures. B. Reduce blood pressure. C. Slow the process of labor. D. Increase diuresis. 53.What is the approximate time that the blastocyst spends traveling to the uterus for implantation? A. 2 days B. 7 days C. 10 days D. 14 weeks 54.After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective? A. Shortens the second stage of labor. B. Enlarges the pelvic inlet. C. Prevents perineal edema. D. Ensures quick placenta delivery. 55.A primigravida client at about 35 weeks gestation in active labor has had no prenatal care and admitted to cocaine use during the pregnancy. Which of the following persons must the nurse notify? A. Nursing unit manager so appropriate agencies can be notified. B. Head of the hospital’s security department. C. Chaplain in case the fetus dies in utero.  D. Physician who will attend the delivery of the infant. 56.When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following? A. The vaccine prevents a future fetus from developing congenital anomalies. B. Pregnancy should be avoided for 3 months after the immunization. C. The client should avoid contact with children diagnosed with rubella D. The injection will provide immunity against the 7-day measles. 57.A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first? A. Pad the side rails. B. Place a pillow under the left buttock. C. Insert a padded tongue blade into the mouth. D. Maintain a patent airway. 58.While caring for a multigravida client in early labor in a birthing center, which of the following foods would be best if the client requests a snack? A. Yogurt B. Cereal with milk C. Vegetable soup D. Peanut butter cookies 59.The multigravida mother with a history of rapid labor who is in active labor calls out to the nurse, “The baby is coming!” Which of the following would be the nurse’s first action? A. Inspect the perineum. B. Time the contractions. C. Auscultate the fetal heart rate. D. Contact the birth attendant. 60.While assessing a primipara during the immediate postpartum period, the nurse in charge plans to use both hands to assess the client’s fundus to: A. Prevent uterine inversion. B. Promote uterine involution. C. Hasten the puerperium period. D. Determine the size of the fundus. 61.Which behaviors would be exhibited during the letting-go phase of maternal role adaptation. Select all that apply. A. Emergence of the family unit. B. Dependent behaviors C. Sexual intimacy continues. D. Defining one's individual roles. E. Being talkative and excited about becoming a mother. 62.While making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:  A. Express a strong need to review the events and her behavior during the process of labor and birth. B. Exhibit a reduced attention span, limiting readiness to learn. C. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn D. Have reestablished her role as a spouse or partner. 63.Which of the following is the most common kind of placental adherence seen in pregnant women? A. Accreta B. Placenta previa C. Percreta D. Increta 64.A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound 65.A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): A. Sometimes uses vibroacoustic stimulation. B. Is an invasive test; however, contractions are stimulated C. Is considered to have a negative result if no late decelerations are observed with the contractions. D. Is more effective than nonstress test (NST) if the membranes have already been ruptured. 66.In the past, factors to determine whether a woman was likely to have a high-risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category? A. Biophysical B. Psychosocial C. Geographic D. Environmental 67.A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? A. "I will need to have a full bladder for the test to be done accurately." B. "I should have my husband drive me home after the test because I may be nauseated." C. "This test will help to determine whether the baby has Down syndrome or a neural tube defect." D. "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." 68.What is an appropriate indicator for performing a contraction stress test?  A. Increased fetal movement and small for gestational age. B. Maternal diabetes mellitus and postmaturity. C. Adolescent pregnancy and poor prenatal care D. History of preterm labor and intrauterine growth restriction. 69.The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts 70.A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? Select all that apply. A. The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. B. The patient can monitor fetal activity once daily for a 60-minute period and note activity. C. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. D. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. 71.A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse’s plan of care after the procedure? Select all that apply. A. Perform ultrasound to determine fetal positioning. B. Observe the patient for possible uterine contractions. C. Administer RhoGAM to the patient if she is Rh-negative. D. Perform a mini catheterization to obtain a urine specimen to assess for bleeding. 72.With regard to small-for-gestational-age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that: A. In the first trimester, diseases or abnormalities result in asymmetric IUGR. B. Infants with asymmetric IUGR have the potential for normal growth and development. C. In asymmetric IUGR, weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA. D. Symmetric IUGR occurs in the later stages of pregnancy. 73.A client who delivered by cesarean section 24 hours ago is using a patient-controlled analgesia (PCA) pump for pain control. Her oral intake has been ice chips only since surgery. She is now complaining of nausea and bloating, and states that because she had nothing to eat, she is too weak to breastfeed her infant. Which nursing diagnosis has the highest priority? A. Altered nutrition, less than body requirements for lactation  B. Alteration in comfort related to nausea and abdominal distention. C. Impaired bowel motility related to pain medication and immobility. D. Fatigue related to cesarean delivery and physical care demands of infant. 74.The nurse is teaching care of the newborn to a childbirth preparation class and describes the need for administering antibiotic ointment into the eyes of the newborn. An expectant father asks, “What type of disease causes infections in babies that can be prevented by using this ointment?” Which response by the nurse is accurate? A. Herpes B. Trichomonas C. Gonorrhea D. Syphilis 75.A new mother is having trouble breastfeeding her newborn. The child is making frantic rooting motions and will not grasp the nipple. Which intervention should the nurse implement? A. Encourage frequent use of a pacifier so that the infant becomes accustomed to sucking. B. Hold the infant's head firmly against the breast until he latches onto the nipple. C. Encourage the mother to stop feeding for a few minutes and comfort the infant. D. Provide a formula for the infant until he becomes calm, and then offer the breast again.